tbuckley/cabot-search huggingface dataset:
12-month secondary outcomes of a prostate cancer survivor symptom self-management intervention.
Authors: Sarah T. Hawley, Tabitha Metreger, Hyungjin Kim, Ted A. Skolarus
Journal: Journal of Clinical Oncology (2022)

373 Background: Long term adverse symptoms following treatment for prostate cancer are prevalent and can negatively impact quality of life and increase healthcare seeking, even though many symptoms can be effectively self-managed. There remains a need for tools to support long term survivors to feel confident in their ability to self-manage their symptoms, potentially translating to more efficient health care utilization. Methods: We conducted a RCT of an automated tailored self-management support intervention (vs. newsletter) for long term (&gt; 1 year) Veteran survivors of prostate cancer recruited from 4/2015-2/2017 across four VA sites. Participants were randomized (278 per arm) and assessed via survey at 5 months and 12 months post enrollment. The intervention delivered tailored information regarding symptoms for urinary, sexual, bowel and general health over 3 months, allowing participants to choose focus areas. At 12 months, we assessed secondary trial outcomes; participants’ reports of use of services relative to their symptoms (urinary, bowel, sexual, general health) and their confidence in symptom self-management (scale from 5-15). We also assessed use of procedures and medications related to each symptom area via medical charts. We tested differences in reported and documented service use between arms using T-tests and Chi-square tests. We further assessed participants engagement in components of the intervention. Results: Of those randomized, 81.7% completed the 12-month survey assessment (N = 226 Intervention and N = 228 Control). The average age was 66.7, 28% were Black, and 49% were high school graduates or less. Participants in the intervention arm reported greater confidence in symptom self-management than controls (Mean: 13.5 vs. 12.9; P = 0.01). Intervention participants reported less often using services related to urinary (43.9% vs. 56.0%, P = 0.03) and sexual (42.3% vs. 57.6%, P = 0.04) health over the prior 7 months. Review of intervention paradata found that urinary and sexual health were the topics most frequently engaged with among intervention subjects. No significant differences in medical chart documented procedures related to symptom areas were found. Conclusions: This secondary trial analysis found that 12 months post enrollment, Veterans who engaged with a tailored self-management intervention were more confident in their ability to self-manage their symptoms. The associated finding of fewer visits for the most commonly chosen areas for symptom self-management suggests that such an intervention may hold promise for helping long term survivors to effectively self-manage adverse symptoms. Clinical trial information: NCT01900561.
Access to treatment among patients with advanced kidney cancer in Mexico.
Authors: Carlos Eduardo Salazar-Mejía, Antonio Piñeiro-Martínez, Angela Leticia Juárez-Villarreal, Arianna Elizabeth Jara-Rios, Ana Patricia Ibarra-Alaniz, Blanca Otilia Wimer-Castillo, David Hernandez-Barajas, Oscar Vidal-Gutiérrez, Lauro Gómez-Guerra, Omar Alejandro Zayas-Villanueva
Journal: Journal of Clinical Oncology (2022)

130 Background: The socioeconomic status of patients diagnosed with metastatic renal cell carcinoma (mRCC) in developing countries could in many cases limit their access to the best available therapeutic options. We aimed to describe the clinical characteristics and access to treatment of Mexican patients with mRCC. Methods: We performed a retrospective analysis of all patients with a histopathologically confirmed diagnosis of renal cell carcinoma who were treated at an oncology referral center in Northeast Mexico over a 5-year period. Results: We included 233 patients in the analysis, of whom 63% were men. The mean age at diagnosis was 58.2 years; 87% of the tumors were histopathologically classified as clear cell carcinoma. Regarding laterality, 54% of the tumors originated from the right kidney. The distribution of cases by clinical stage (CS) was as follows: CS I 15%, CS II 8%, CS III 17%, CS IV 60%. All of the included patients had government health insurance coverage; however, specific treatment for renal cell cancer was not included in this coverage. In terms of access to first-line systemic management in the 139 patients with advanced kidney cancer who were candidates for treatment, 29% received treatment with a single-drug tyrosine kinase inhibitor (TKI), 4% were treated with combined or single-drug immunotherapy (IO), and 12% were treated with TKI combined with IO. All but one patient who was treated with a single drug or a combination of IO received these drugs in the context of a clinical trial. Fifty-five percent of patients with advanced disease did not have access to standard first-line therapy. The rate of loss to medical follow-up was 69% of cases. Conclusions: Despite the proven oncological benefit of the latest generation of therapies based on IO/IO or IO/TKI for mRCC, access to first-line standard management is still poor in our country, even with single agent TKI. Public health programs should be implemented to expand therapeutic options for this group of patients.
Real-world utilization of liquid biopsy for epidermal growth factor receptor (EGFR) testing in patients with metastatic non-small cell lung cancer (mNSCLC).
Authors: Anne Shah, Jon Apple, Debra L. Ryan, Kevin de Silva, Ling Cai, Rahul Shenolikar
Journal: Journal of Clinical Oncology (2022)

402 Background: Tissue biopsy (TB) testing is the standard of care to guide the selection of targeted therapy in EGFRm patients with mNSCLC. However, liquid biopsy (LB) tests are increasingly important in assessing tumor genomics at mNSCLC diagnosis. This study assessed real-world utilization of LB for EGFR testing in 1L setting and its influence on 1L treatment decisions in mNSCLC patients. Methods: Adults newly diagnosed with mNSCLC from January 1, 2019 to May 31, 2021 and treated with 1L were identified from the Flatiron EMR database. LB utilization and patterns (either used alone or in combination with TB) were evaluated. “Concurrent” (TB &amp; LB) testing was defined as patients with both test order dates prior to result dates for either test, while “sequential” (TB &amp; LB) testing was defined as patients having one test’s result date before the other test’s order date. As patients could have multiple biomarker tests, the first two EGFR tests following diagnosis were evaluated. Results: Of 5,036 patients that met the study criteria, 89.2% (N = 4,494) had EGFR testing following diagnosis. Among those tested for EGFRm, 63.7% (N = 2,864) had TB only, while 36.3% (N = 1,630) had LB (LB only: 37.9%; concurrent: 36.1%; sequential: 26.0%). Around 90% of patients with LB had NGS testing (87.7% received LB testing within 90 days of diagnosis). Among patients who initiated 1L after EGFR testing, the median (IQR) time in days from testing to 1L initiation varied by testing patterns: LB only: 18 (12-30); concurrent: 29 (22-39); sequential: 28 (18-41). Disagreement in test results was 10.6% for patients who had conclusive test results for both TB and LB tests. Among concurrent EGFRm patients (N = 130), 21.5% initiated 1L after receiving LB results (and before TB results) and 60.0% after receiving both test results. Among patients with sequential LB followed by TB (N = 10), 80.0% of them initiated 1L after receiving LB results and before TB results (Table). Conclusions: In this real-world study among mNSCLC patients in a 1L setting, more than one-third used LB for EGFR testing, either alone or in combination with TB. Among LB patients, majority had NGS testing.[Table: see text]
Increasing tobacco cessation counseling and referral in a statewide oncology collaborative.
Authors: Mariem Ruiz Martinez, Jennifer J. Griggs, Manlan Liu, Kelly DeVries
Journal: Journal of Clinical Oncology (2022)

327 Background: Oncology providers are uniquely positioned to provide tobacco cessation interventions because the motivation to quit can increase at the time of a cancer diagnosis. Physician advice to quit smoking increases the likelihood of a quit attempt by 25%. The Michigan Oncology Quality Consortium (MOQC), a physician-led quality improvement consortium of nearly all oncology practices in Michigan, has made tobacco cessation counseling and referral a priority. Methods: The Michigan Oncology Quality Consortium (MOQC) began abstracting tobacco cessation counseling and referrals from oncology medical records into the Quality Improvement Practice Initiative (QOPI) platform of the American Society of Clinical Oncology (ASCO) beginning in 2014. MOQC has developed and disseminated effective resources to ensure that practices in the consortium have access to tobacco cessation services through a grant to the Michigan Department of Health and Human Services (MDHHS). In 2017, performance on this measure was selected as one of our value-based reimbursement (VBR) measures. We also compared our data with responses from the Behavioral Risk Factor Surveillance System (BRFSS) obtained through MDHHS in response to the following question: “Earlier you indicated that you currently smoke cigarettes. Has your doctor or other health professional ever advised you of, or referred you to, a program or other resources available to help you stop smoking?”. Results: Between 2015 and 2021, 6,048 patients were included in the measure denominator. In 2015, only 44% of patients had documented counseling or referral to tobacco cessation services. Performance on this measure has increased each year as shown in the table. Data from the BRFSS Michigan Department of Health and Human Services (MDHHS) also show year-over-year improvement in patient reports of having been advised to quit. Conclusions: Our statewide collaborative successfully increased the proportion of patients who smoke who were either counseled to quit smoking or who were referred to smoking cessation services. The decrease in performance in 2020 and 2021 was likely to be the result of the COVID-19 pandemic. The addition of the VBR may have contributed to the success of our program. Through a partnership with HBOM- Health Behavior Optimization for Michigan, MOQC will create additional measures to continue to incentivize practices to get back to pre-pandemic levels of tobacco cessation referrals.[Table: see text]
Fostering Oral Chemotherapy Understanding and Safety (FOCUS) Project: Interventions for improving knowledge and compliance with national safety standards.
Authors: Jessica MacIntyre, Rita D'Aoust, Deborah Baker, Ginger Hanson, Lauren Nicole Gjolaj, Chaitra Swain Simpson, Lawrence M. Negret, Daniel O'Neil
Journal: Journal of Clinical Oncology (2022)

370 Background: Oral chemotherapy drugs are not always subject to the same safety standards as intravenous chemotherapy. Variability in safety practices can cause gaps in care, creating a need for continuous review of this process. This quality improvement (QI) project sought to improve provider and staff general knowledge on oral chemotherapy and on national safety standards through an educational intervention and to evaluate the implementation of an electronic medical record (EMR) integrated chemotherapy documentation template geared towards improving compliance with national safety standards pertinent to oral treatment. Methods: We used a pre/post-test design to compare knowledge following an educational session. A 15-question test covering national guidelines and safety standards relevant to oral chemotherapy were used to evaluate base knowledge before and after the session. We compared pre and post-test scores using paired t-tests. Then, a chemotherapy documentation template was developed in the EMR. The medical records of 44 patients at the center were reviewed four months before and 44 patients one month after the template’s introduction and documentation compliance was assessed using 24 national chemotherapy administration safety standards from the American Society of Clinical Oncology (ASCO) Quality Oncology Practice Initiative and the 2016 ASCO/Oncology Nursing Society Chemotherapy Administration Safety Standards. Comparison of compliance rates were performed using independent t-tests. Results: A total of 65 providers and staff participated in the educational session and completed both the pre and post-test. There was a statistical significance in knowledge gained from pre-test to post-test (p value of &lt; 0.001). Additionally, from the 88 charts reviewed, there was a statistical improvement in compliance with national safety standards (p value of &lt; 0.001). The participants (n = 29) also scored the documentation template as above average indicating overall ease of use and feasibility for continued use. Conclusions: This QI initiative improved provider knowledge and compliance with oral chemotherapy national safety standards. As a result, more centers should focus efforts on awareness and utilization of established national safety guidelines; critical to addressing the disparities in practice. Additionally, having a standardized workflow that prompts documentation within the EMR and discussion of the national standards is key to quality and safe practice.
Transparency and representation in clinical research utilizing artificial intelligence in oncology: A scoping review.
Authors: Anjali D'Amiano, Tia Cheunkarndee, Chinenye C. Azoba, Danielle Sara Bitterman, Raymond H. Mak, Subha Perni
Journal: Journal of Clinical Oncology (2022)

308 Background: Artificial intelligence (AI) has significant potential to improve health outcomes in oncology. However, lack of demographic representation in data sets used to train and test these models can lead to model bias and potential disparities. We sought to assess transparency in reporting and representation of race, sex, and age data in published clinical studies utilizing AI in oncology. Materials and Methods: In this scoping review, we used PubMed to search for peer-reviewed research articles published between 2016 and 2021 with the query type “(“deep learning” or “machine learning” or “neural network” or “artificial intelligence”) and (“neoplas$” or “cancer$” or “tumor$” or “tumour$”).” We included clinical trials and original research studies and excluded reviews and meta-analyses. Oncology-related studies that described data sets used in training or validation of the AI models were eligible. Three investigators reviewed eligible studies to collect data regarding public reporting of patient demographics, including age, sex at birth, and race. We used descriptive statistics to analyze these data across studies. Results: Out of 220 total studies, 118 were eligible and 47 had at least one described training or validation data set. Of these, 69 studies (58%) reported age data for patients included in training or validation sets, while 60 studies (51%) reported sex and 6 studies (5%) reported race. Across studies, age ranged from 16 days-96 years. For studies that reported mean age, the overall mean was 57.8+/- 10.8 years. 48.5% of patients included in studies with reported sex were male, and 51.5% were female. 38 studies (63.3%) that reported sex included a majority of males, and 22 studies (36.7%) used a majority of females. From the 6 studies that reported race, 70.7%-93.4% of individuals were White. Only 3 studies (2.5%) reported racial demographic data with more than two categories (i.e. “White” vs. “non-White” or “White” vs. “Black”). Conclusions: In this scoping review of published studies in oncology using AI models, we found that a minority of studies reported complete demographic data of training and validation sets. In particular, studies rarely reported race, and those that did had few non-White patients. Increased transparency regarding demographic data of patients included in data sets for creation of AI models is essential to ensure fair and unbiased clinical integration of AI.
Changing the electronic health record to optimize pre-chemotherapy lab orders.
Authors: Barbara Lam, Melis Celmen, Tim Graham, Tenzin Dechen, Jessica Ann Zerillo
Journal: Journal of Clinical Oncology (2022)

434 Background: National guidelines support screening for infectious diseases and pregnancy before starting cancer-directed treatment. Providers also check liver and kidney function to ensure safe medication dosing. Forgetting to order these tests has implications for patient safety and treatment area throughput. Our aim was to modify the provider order entry (POE) screen in the electronic health record (EHR) to reduce missed laboratory orders for hepatitis B, pregnancy tests, and organ function.Methods: We revised the hematology/oncology POE screens so that labs were grouped by organ system rather than listed alphabetically. A new Pre-Treatment Screening (PTS) order set includes urine pregnancy and a hepatitis B panel. We collected retrospective ordering data at our medical center’s ambulatory academic and community sites from the pre-intervention (10/20 – 9/21) and post-intervention (10/21 – 4/22) time periods. Data was analyzed to determine the pre/post change in percentage of add-on chemistry tests, rate of ordered urine pregnancy and hepatitis B tests in new patients, and proportion of positive hepatitis B tests. Results: There were 165,360 total chemistry lab orders pre-intervention and 91,948 post-intervention. The percentage of add-ons decreased from 0.50% (834/165,360) to 0.38% (351/91,948). There were 1,109 pre-intervention new treatment starts (92/month) and 673 post-intervention (96/month). The rate of hepatitis B screening increased from 86/month to 99/month and the rate of urine pregnancy testing remained the same at 4/month. The proportion of positive hepatitis B surface antigen tests increased from 0.72% (8/1109) to 0.89% (6/673). The proportion of positive hepatitis B core antibody tests decreased from 9.83% (109/1109) to 9.51% (64/673). Conclusions: Simple changes to an electronic ordering screen were associated with increased adherence to pre-treatment screening guidelines. Further PDSA cycles are needed to explore what changes to POE can optimize appropriate utilization of lab orders, especially for pregnancy screening. This has far-reaching consequences not only for new chemotherapy patients but also for other populations receiving immunosuppressive treatments.
Reasons for declining participation in breast cancer trials among minorities at a safety-net health system.
Authors: Fabian E. Robles, Nasir Qureshi, Nisha Unni, Samira K. Syed, Hsiao Ching Li, Navid Sadeghi
Journal: Journal of Clinical Oncology (2022)

95 Background: Despite increasing awareness, racial and ethnic minorities remain under-represented in clinical trials. Understanding patients’ reasons to decline participation can help tailor solutions to improve minority enrollment in cancer trials. Methods: Parkland Health (Dallas County, TX) is a safety-net health system, and affiliated with the UT Southwestern/Harold C. Simmons Comprehensive Cancer Center (SCCC). Over 80% of the breast cancer patients treated at Parkland belong to racial and ethnic minorities. Potential study candidates are referred to the clinical trial support team, which includes a Hispanic bilingual patient navigator. Patients who decline to participate are asked to describe their reasons. Data for screening and accrual to therapeutic breast cancer trials at Parkland between January 2021 and May 2022 is presented here. Results: A total of 193 potential study candidates were referred to the trial support team in the pre-screening phase. Ninety-five patients (49%) were excluded after screening (screen-fails). Of the 98 patients who met all study specific eligibility criteria, 93% belonged to minorities: 69% (68/98) Hispanics and 23% (23/98) Blacks. Thirty-one patients (32%) declined participation in clinical trials. Compared to Hispanics, Black patients were more likely to decline participation: Blacks 65% (15/23) vs Hispanics 19% (13/68); p &lt; 0.0001. Patients' reasons for declining to participate in trials included: lack of interest (14/31), excessive trial requirements such as extra biopsies (8/31), and potential delay in treatment due to additional tests (5/31). Four patients declined participation in a de-escalation trial due to the fear of inferior outcomes with less treatment. Among patients who declined participation, 53% of Blacks and 23% of Hispanics cited lack of interest as the reason (p = NS). Conclusions: We observed a higher participation rate among Hispanics, which may in part reflect the impact of having a bilingual research navigator from the same ethnic background. Lack of interest was a major reason to decline, particularly among Blacks. Strategies focused on patient education and trust are being implemented to further improve minority participation in trials at our institution.
Hospital at Home in an oncology setting: Updated analysis.
Authors: Melanie Wain Kier, Sara Lubetsky, Gabrielle Schiller, Albert L. Siu, Katherine A. Ornstein, Cardinale B. Smith
Journal: Journal of Clinical Oncology (2022)

257 Background: Hospitalization at Home (HaH) is an emerging clinical model that delivers the essential elements of acute hospital-level care in the home and has demonstrated efficacy largely for inpatient medical conditions. Few programs have implemented HaH for patients with active cancer diagnoses. There is little data evaluating the impact of HaH on cancer outcomes, patient experience or cost effectiveness. In 2019, the Mount Sinai Health System (MSHS) expanded its HaH program to include oncology patients. Here, we describe our institution’s experience of HaH in oncology as we continue to increase enrollment. Methods: We performed a retrospective chart review for solid tumor, myeloma and lymphoma patients at MSHS from August 2019 to April 2022 enrolled in HaH. Our updated analysis includes additional patients from what was previously presented at ASCO Annual Meeting June 2022. Patient eligibility for HaH required meeting established institutional HaH admission criteria. Demographics, cancer diagnosis, social situation, indication for antecedent ED or inpatient stay, and HaH admission were extracted from the electronic medical record. Our primary endpoint was rate of successful HaH admission, with success defined as discharge from HaH for complete recovery from the acute condition or transition to hospice. We also evaluated patient social support and home resources. Results: We enrolled 27 patients with multiple myeloma (n = 13), lymphoma (n = 1), and solid tumor (n = 13), which is an additional 8 patients from the data presented prior. Sixty-three percent (n = 17) were male, 67% (n = 18) were age 65 or older, and 33% (n = 9) were white. Patients were enrolled in HaH either from an inpatient service (n = 21) or from the emergency room (n = 6). While on the inpatient service, 12 of the 21 patients had received chemotherapy. Post-chemotherapy monitoring was the primary reason for HaH admission. Successful HaH admissions occurred for 85% (n = 23) of patients. The mean duration of HaH admission was 5.6 days (range 1-13 days). Four patients opted to re-enroll in HaH planned care at a later point. There were no significant issues with provider home visits, access, medication delivery, lab draws, or social support. Conclusions: The MSHS Oncology HaH program successfully cared for 85% of our cohort demonstrating the functionality of expanding the program to patients with cancer. We continue to increase enrollment and develop clinical pathways available on hospital at home for our oncology patients.